Tuesday, April 1, 2014

What's Changed In Treatment And Diagnosis Of Cushing's Since Viva's Treatment

The post is shared with us by my good friend @Kenzo_HW. Check out his blog, it's got awesome information on Hovawarts, tracking, nose work and lot's of other great stuff.

The treatment and diagnosis of Cushing's disease is under constant improvement and research. 

During the years Viva had Cushing's, a lot already changed, and more changes are ahead. If there is one thing Viva and me learned, it is that this is not not a disease you can manage by simply sticking a pill. Uou have to be constantly on your toes, and take the clinical signs you notice very seriously.

Cushing's is caused by a tumor in the pituitary or the adrenal gland, causing an over-production of ACTH hormones which in turn trigger an overproduction of cortisol. A potentially life-threatening condition affecting inner organs like kidneys and liver.

Some of the most common signs are hair-loss, a pot-belly, lethargic behavior, incontinence, and being overly interested in food and water.

Cushing's is often mistaken for normal aging signs of dogs, making it a silent killer.

This is what we learned along the way:


Back in 2011, Viva was diagnosed with Cushing's based on a urine test and a ACTH stimulation test. During her life, she continued to have ACTH tests quarterly to measure her cortisol levels for possible adjustment of her drug dosage.

Although the ACTH stimulation test is reliable to measure levels for treatment adjustments, it proved unreliable for the diagnosis itself, when the results are negative

Negative test results should always be followed up by at least an LDDS test, and even better, by an ultrasound, to indicate the type of Cushing's which is significant for what treatment options are available.

Large dogs

The recommended dosage of Trilostane (Vetoryl), the medication for Cushing's disease, was set too high for larger dogs. Something Viva found out the hard way. Thankfully, our vet read the signs correctly and adjusted her medication far below the recommended dosage for a dog of her size.

Later, in 2012, research was done that confirmed that at least dogs weighing more than 30 kg. need a significantly lower dosage of Trilostane, maybe even dogs weighing more than 15 kg.

Once or twice a day administering of medication

The last has not been said on this subject.

Generally Trilostane works up to 8-10 hours, and that might require a twice-a-day administration, instead of an only once daily which is the standard.

Research is still being done, and some vets are already recommending twice daily administration of Vetoryl. At least some research here and here has shown, there is hardly risk in trying. We never got that far with Viva, it was something I was discussing with our vet, as I could see she consistently was showing more lethargic signs during the end of the day.

A dog with Cushing's requires continuous research, together with your vet, and to be vigorous about measuring the clinical signs of your dog.

We always kept a Cushing's diary, and it was a great help in supporting Viva in her battle against Cushing's.

Whatever research was available at the time, or not, the diary was always right.


Kenzo is the founding father of Kenzo the Hovawart blog. We got him as a puppy from a responsible breeder. Kenzo is an active dude and has participated in a lot of different dog training activities like obedience, "schutzhund", tracking and nosework. He even attended dog shows - alright, one - with good results.

Hovawart males tend to rival a lot with other male dogs, but Kenzo is one of the exceptions. He is just friendly by nature. A dog with a heart of gold.

Viva was adopted from the shelter when she was 5 years old, and we don't know a lot of her history. Viva came with a lot of health issues and fear of most other dogs, but is doing a lot better today. She is very persistent and has an iron will. When Viva wants something, she doesn't give up easily.

She loves to go for walks in large open spaces, where she can be sure there are no other dogs and she can investigate her surroundings undisturbed.

We are all living together in Copenhagen, Denmark.

Related articles:
Viva Has Cushing's 
Living With A Cushing's Dog: Viva's Story 

Cortisol: What Happens In A Dog’s Body When It Goes Awry?
Veterinary Highlights: Analysis Of Dog Hair Reveals Hormonal Imbalance 

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

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